Factors affecting the utilization of antenatal care among married women of reproductive age in the rural Thatta, Pakistan: findings from a community-based case-control study

Abstract

Background: There are differences in antenatal care (ANC) utilization between urban and rural areas of Pakistan. Although multiple factors have been studied affecting the utilization of general health care services, the effect of road network distance particularly on the utilization of ANC has not been assessed. Therefore, this study aimed to determine the association between road network distance from a health care facility and utilization of the ANC among women of reproductive age in Thatta Pakistan. Methods: A community-based case-control study was conducted in district Thatta, Pakistan. Women who did not utilize ANC services during their last pregnancy were considered as cases, while controls were the women who utilized ANC services during their last pregnancy. Questions related to socio-demographic, access-related factors and utilization of ANC were asked from women. Road network distance was calculated from the women's home to the health care facility providing ANC services. Logistic regression analysis was performed. Results: A total of 380 participants were interviewed in this study. Participants' mean age and parity were 28 years (SD 5.65), and 3.5 (SD 2.6) respectively. The multivariate analysis showed that women living at a shorter distance of less than 5 km were 1.21 times likely to utilize ANC services [Adjusted OR. 1.21; 95% CI (0.49-2.99)]. Moreover, nulliparous women were 4.10 times likely to utilize antenatal care [Adjusted OR. 4.10; 95% CI (1.10-15.26)]. Similarly, women who had knowledge of antennal care were 6.60 times likely to utilize ANC services [Adjusted OR. 6.60; 95% CI (3.33-13.05)]. Women having electricity in their households were 3.15 times likely to utilize the ANC services [Adjusted OR. 3.11 95% CI (1.51-6.41)]. Women, living in well-constructed (Pakka) houses were 2.58 times likely to utilize the ANC services [Adjusted O.R: 2.58; 95% CI (1.15-5.82)]. Conclusion: Road network distance has no measurable impact on ANC utilization among married women in Thatta district, Pakistan. Nulliparous women having knowledge of ANC living in well-constructed houses equipped with electricity were found to be utilizers of ANC services. It is recommended that awareness and health education sessions should be arranged for pregnant women in rural Pakistan.

Magnitude and Determinants of Antenatal Care Utilization in Kandahar City, Afghanistan

“…This figure is higher than the national level (59%) reported by ADHS in 2015 [ 5 , 6 ] and comparable with another study conducted in Kandahar province [ 27 ]. The rate of ANC utilization in the present study is consistent with those asserted in many studies conducted in other developing countries, such as Rwanda, Bangladesh, Jordan, and Ethiopia [ 7 – 11 , 18 , 23 ]. This finding epitomizes many developing countries where a substantial proportion of pregnant women fail to regularly make their ANC visits.…”

“…This is the first study, of which we are aware, to determine the magnitude of ANC services utilization and its determinants among women who had at least one delivery in the last two years in Kandahar city. The results of this community-based cross-sectional study were consistent with the findings of other pertinent studies conducted in developing countries [ 7 – 11 , 18 , 23 ]. We found that ANC utilization was highly associated with the educational status of the mother, pregnancy intention, and her place of residence.…”

“…Perpetual findings of extensive research conducted in the developing world indicate that diverse factors such as maternal age [ 7 , 8 ], maternal education [ 6 , 8 – 10 ], household income [ 8 , 10 ], husband education [ 8 , 11 ], maternal employment [ 12 , 13 ], area of residence [ 8 , 10 , 14 ], pregnancy intention [ 15 , 16 ], media exposure [ 16 – 18 ], pregnancy-linked cost [ 19 , 20 ], history of obstetric complications [ 11 , 21 ], parity [ 11 , 22 ], lack of ANC knowledge [ 23 – 25 ], and the distance from a health facility [ 25 , 26 ] are associated with ANC utilization.…”

We Won’t Go There: Barriers to Accessing Maternal and Newborn Care in District Thatta, Pakistan

“…They cited the apathetic attitude of staff and poor service delivery as major reasons for avoiding these facilities. This finding is consistent with a national survey which reported that only 32.6% of patients attend public health facilities in Pakistan [23]. Different studies have also pointed out that private health facilities are preferred in Pakistan due to better facilities and quality of care [24][25][26].…”

“…Despite this mounting evidence, no study to date has conducted an in-depth exploration of the multi-faceted barriers to maternal and newborn health service utilization in rural Pakistan. Previous studies have determined the rates of service utilization without exploring the sociocultural determinants of health-seeking behavior [22][23][24]. Addressing this gap, we designed this interpretive study to interact with both community members and health care providers to identify the multifaceted barriers to health service utilization in rural Pakistan.…”